Reactivity to trichophytin antigen in patients with onychomycosis: Effect of terbinafine - 01/09/11
Abstract |
Background: Many patients with chronic dermatophytosis and onychomycosis have depressed cell-mediated immunity (CMI) to trichophytin. Objective: The fungicidal properties of oral terbinafine provide a unique opportunity to explore whether elimination of antigen could restore CMI response in these patients. Methods: A double-blind, placebo-controlled study evaluated the effect of terbinafine (250 mg/d for 12 weeks) on skin immunoreactivity to intradermal trichophytin antigen (TRIPA), mycologic status of the nail, and nail growth in patients with toenail onychomycosis. Results: Skin reactivity, in an optimized, dose response challenge series to TRIPA was inversely related to disease chronicity. Mycologic/clinical response rates were 72%/84% for terbinafine and 0%/7% for placebo. Terbinafine increased the number of TRIPA reactors 2-fold and the mean TRIPA reaction area 4-fold; responses in placebo-treated patients were relatively unchanged. Of the 7 (of 25) patients receiving terbinafine who still had positive mycology 6 months after treatment, all were anergic to TRIPA at baseline and all but one remained so after treatment. Conclusion: Terbinafine treatment enhances and restores CMI to TRIPA in patients with Trichophyton rubrum onychomycosis and may thereby reduce susceptibility to reinfection. Terbinafine reversal of immunologic anergy may be an important model of microbial tolerance in chronic dermatophyte infections. (J Am Acad Dermatol 2002;46:371-5.)
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Supported in part by Novartis as an unrestricted, educational grant to the Department of Dermatology at Case Western Reserve University. No authors have received personal financial support for this study. |
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Conflict of interest: Drs Elewski, Cooper, Ghannoum, and Birnbaum are or have been consultants for Novartis, and Dr Birnbaum was formerly employed by Novartis. Dr Elewski has also been a consultant for Pfizer, Janssen, Ortho, Berlex, and Medicis. Dr Ghannoum has also been a consultant for Pfizer and Merck. Dr El Charif has no pharmaceutical funding sources. |
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Reprint requests: Boni E. Elewski, MD, Department of Dermatology, University of Alabama, Birmingham, AL 35233. E-mail: beelewski@aol.com. |
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*Current locations: the Department of Dermatology, University of Alabama, Birmingham, Alabama (B. E. E.) and Montville, New Jersey (J. E. B.) |
Vol 46 - N° 3
P. 371-375 - mars 2002 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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